MEDICARE: JEFFREY D VENABLE LCPC, LADC, CCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAC5747	ME
2	101YM0800X	Mental Health Counselor	CC5131	ME

General Provider Information

NPI Number	:	1952782369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY D VENABLE LCPC, LADC, CCS

Provider Business Mailing Address
First Line	:	178 COURT ST STE 204
Second Line	:
City	:	AUBURN
State	:	ME
Zip	:	04210-6917
Country	:	US
Telephone Number	:	530-746-8018
Fax Number	:

Provider Business Practice Location Address
First Line	:	178 COURT ST STE 204
Second Line	:
City	:	AUBURN
State	:	ME
Zip	:	04210-6917
Country	:	US
Telephone Number	:	530-746-8018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	11/10/2022

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